Suffolk Tax Grievance
235 Candlewood Path, Dix Hills, New York 11746
Office: (631) 242-1213 ● Fax: (631) 242-1285 ● E-mail: firstname.lastname@example.org
DESIGNATION OF REPRESENTATIVE AND AUTHORIZATION 2024/2025
Designation of Representative: I, , as petitioner (or officer thereof) hereby retain and designate Platinum Tax Grievances, herein after referred to as PTG, as my sole agent in any and all proceedings before the Board of Assessment Review and/or Small Claims assessment review of the Supreme Court, and any other proceeding pursuant to New York State Real Property Tax Law for the purpose of reviewing the assessment of my real property as it appears on the most recent assessment roll of any assessing unit for my property. PTG will prepare and file in a timely manner on my behalf the necessary grievance documents and, at PTG’s discretion, file a Small Claims Assessment Review (SCAR) appeal. In addition, PTG is authorized to request and receive any refunds resulting from the lowering of the real property assessment and apply it to their fee; all remaining funds will be immediately reimbursed to me. I warrant and represent that I have full power and authority to enter into this Agreement, and am under no disability or prohibition that would prevent the performance of the obligations hereunder.
Eligibility: I understand that only the following person(s) is eligible under law to receive a property tax refund: 1) a person named in the records of the county clerk as a homeowner; or 2) the homeowner’s agent; or 3) a contract vendee; or 4) the estate of a deceased homeowner. By signing this agreement, I hereby declare that I am one of the aforementioned listed persons and therefore eligible to receive a property tax refund.
Retainer Agreement: I agree to pay PTG as follows:
By signing this authorization, I acknowledge and understand the following:
I have fully read, understand, and agree to the terms and conditions of this agreement.
Mailing Address (if different):
Complete this form to the best of your ability.
Cape Splanch Colonial Split Condo/Townhouse Victorian High Ranch Ranch
Basement: Yes No Full Partial Fully Finished Partially Finished
Garage: Yes No
Waterfront: Yes No
Water View: Yes No
Central Air: Yes No
In-Ground Pool: Yes No
Do you live in the home? Yes No
Was this a foreclosure, distress, estate, short, or family sale? Yes No
Any negative aspects of your home that might affect its value? Yes No
Property offered for sale within the last 3 years? Yes No
Did you read and sign the authorization accompanying this form? Yes No
If you are moving or planning to move, please fill out the information below so we can expedite any refund that may be due to you. Once you have a forwarding address, it is YOUR responsibility to inform us.
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Suffolk Tax Grievance
Agree & Sign